UK study links frequent antibiotic use to higher risk of hospitalization

first_imgA large study of electronic health records in the United Kingdom has found a link between the number of antibiotic prescriptions and the risk of infection-related hospitalization.The study, published today in BMC Medicine, found that patients with more antibiotic prescriptions had a higher risk of infection-related hospital admissions over time, with the risk increasing along with the number of prescriptions. Patients who had received more than nine antibiotic courses in the previous 3 years were found to be more than twice as likely to be admitted to the hospital with an infection within 3 to 6 months as those who’d received one course of antibiotics or fewer.The authors of the study say the findings indicate that repeated prescribing of antibiotics, a common practice in UK primary care offices, has limited clinical benefit and could be increasing the risk of adverse outcomes.Risk rises with number of prescriptionsFor the population-based cohort study, researchers from the University of Manchester and Public Health England analyzed health records from two databases covering primary care practices in England and Wales—the Clinical Practice Research Databank (CPRD) and Secure Anonymized Information Linkage (SAIL) databases.The study population consisted of more than 2 million patients prescribed an antibiotic from 2000 through 2017 for common infections, such as upper and lower respiratory tract infections, urinary tract infections, and ear infections. The analysis was restricted to patients with at least 3 years of history in the databases.The primary outcome analyzed was hospital admission with infection-related complication that occurred in the 6 months after an antibiotic prescription. The researchers divided the patients into five groups based on the number of antibiotic prescriptions received in the previous three years: 0 to 1, 2, 3 to 4, 5 to 8, and 9 or more.Overall, repeated antibiotic use was frequent, with patients in both databases on average receiving seven antibiotic prescriptions in the previous 3 years. Incidence of hospitalization linked to an infection was highest within the first 3 days after a prescription, and hospitalization rates were similar among all groups.The adjusted incidence rate ratio (IRR) among CPRD patients was 0.90 (95% confidence interval [CI], 0.77 to 1.04) when comparing infection-related hospitalization after 3 days in patients with the most previous antibiotic use (9 or more prescriptions) compared with those with the least. In both databases, most hospitalizations were for lower respiratory tract infections and pneumonia.As time went on, infection-related hospitalization decreased, but much less so for patients with more frequent prior antibiotic use, who showed a sustained higher risk of hospitalization over time compared with the lowest-use group. The associated risk was highest in those who’d received 9 or more antibiotics in the previous 3 years. Within 4 to 30 days after a prescription, the rates of hospitalization were more than 50% higher (adjusted IRR, 1.52; 95% CI, 1.34 to 1.72). Differences were even larger in the 3 to 6 months after a prescription (adjusted IRR, 2.26; 95% CI, 1.92 to 2.67).The results were broadly similar in patients from the SAIL database, and were also similar when the analysis looked at patients with and without comorbidity.Frequent antibiotics don’t help, may hurtThe researchers say it’s unclear what exactly is behind the association between increased hospitalization risk and more frequent antibiotic use, but they offer a few potential explanations. For one, the results could be affected by patients who are immunocompromised and as a result suffer more infections, or have been colonized with resistant bacteria from previous hospitalizations.In addition, frequent antibiotic use could be causing increased resistance, resulting in infections that are harder to treat and require hospitalization.But another possibility—one that’s been suggested in previous research—is that frequent antibiotic use could be disrupting the balance of bacteria in the gut (the intestinal microbiota) in ways that enable colonization with resistant pathogens or make patients more susceptible to infections caused by those pathogens. The researchers acknowledge, however, that their study does not provide direct evidence to support this hypothesis, and that further work is needed to test it.While that question remains unanswered, the researchers conclude that what’s clear from this study and previous studies is that there is little evidence that frequent and repeated antibiotic use for common infections is actually clinically effective.”In conclusion, there is little evidence in the literature for the clinical effectiveness of repeated antibiotic use in primary care although [it] is common practice,” they wrote. “Antimicrobial stewardship interventions should target these patients with high use of antibiotics but apparently limited value.”last_img read more

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Danieli Corus commissions blast furnace

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Regional Markets – Focus on: South America

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Joint venture: Messer invests in Malaysia

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DNV GL Moves to New HQ in Singapore

first_imgDNV GL, one of the world’s leading ship classification societies and risk and sustainability service providers with over 500 employees in Singapore, has consolidated its operations in its new headquarters to meet the growing demand for its services in the region.The new headquarters was officially opened today by Mr S Iswaran, Minister for the Prime Minister’s Office, Second Minister for Home Affairs and Second Minister for Trade & Industry Singapore, and DNV GL President and CEO Dr Henrik O. Madsen.The new, state-of-the-art office will house DNV GL operations for Singapore and the surrounding Asia Pacific region. This means that DNV GL’s expertise and regional management team will be under one roof. The relocation to a new technologically advanced building will create greater synergies across its four key business areas – Maritime, Oil & Gas, Energy and Business Assurance.“Singapore is one of the main Asia Pacific locations for the head offices of large international companies and many of our customers are also located here. Besides, Singapore’s vision is very much aligned with DNV GL’s, especially when it comes to research and development work to address the challenges faced in both the offshore oil & gas exploration and clean energy industries,” said Dr Madsen.“Designed to accommodate our growth over the next 20 years, the relocation of the Singapore office also comes at the perfect time. The merger of DNV and GL last September has created a need to integrate the operations of both companies and the new office enables us to do that seamlessly in Singapore,” he added.Collaborative agreementsRecognising the importance of collaboration, DNV GL will also be signing memoranda of understanding (MOU) with the National University of Singapore and the Nanyang Technological University for joint R&D activities. “We firmly believe that our collaborative innovation model will contribute to Singapore’s fast moving industries,” said Dr Madsen. “Also, as an independent foundation with a strong technology base and risk management as our core area of expertise, we will continue to fill a unique role in creating trust and confidence among industry stakeholders.”Located at 16 Science Park Drive, DNV GL’s new office brings together 500 employees from the company’s previous four offices around the island. [mappress]Press Release, February 27, 2014last_img read more

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Hansom: Gift of the gab

first_imgSubscribe now for unlimited access Stay at the forefront of thought leadership with news and analysis from award-winning journalists. Enjoy company features, CEO interviews, architectural reviews, technical project know-how and the latest innovations.Limited access to building.co.ukBreaking industry news as it happensBreaking, daily and weekly e-newsletters Get your free guest access  SIGN UP TODAY To continue enjoying Building.co.uk, sign up for free guest accessExisting subscriber? LOGIN Subscribe to Building today and you will benefit from:Unlimited access to all stories including expert analysis and comment from industry leadersOur league tables, cost models and economics dataOur online archive of over 10,000 articlesBuilding magazine digital editionsBuilding magazine print editionsPrinted/digital supplementsSubscribe now for unlimited access.View our subscription options and join our communitylast_img read more

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Building the Nafta Railway

first_imgINTRO: Kansas City Southern has moved from a 2750 km regional carrier to a 16000 km international network, ideally placed to tap the expanding opportunities generated by the North American Free Trade Agreement BYLINE: Michael R HavertyPresident & Chief Executive OfficerKansas City Southern RailwaySIGNING OF the North American Free Trade Agreement between the United States, Canada and Mexico on October 7 1992 transformed at a stroke the continent’s railway landscape. Both in Canada and the USA, the biggest rail flows have been east – west, linking the industrial hubs along the Atlantic seaboard with the burgeoning cities of the Pacific Rim.But Nafta changed all that. Suddenly the new axis of economic growth was aligned north-south. The east-west railroads scrambled for opportunities to create corridors linking Mexico with Canada. In the heart of the continent, one railway was already well placed to take advantage of the trend.The Kansas City Southern Railway was originally conceived as a link between the US heartland and the Gulf of Mexico, way back in 1897. The founder Arthur E Stilwell envisaged a railway running south from the geographic centre of the United States to a port on the Gulf. From here commodities could be shipped to the east and west coasts, Europe, Asia and South America.Stilwell was unconcerned that his concept ran counter to conventional wisdom, when the 19th century railroad barons were rushing to build east-west routes. He anticipated considerable opportunities for growth along his corridor – and far less competition!Backed by foreign investors (KCS was not a land-grant railroad), Stilwell succeeded in building a line from Kansas City, Missouri, to Port Arthur, Texas (named after Stilwell). Later he planned another line across the border into Mexico, heading towards the Pacific Ocean, known as the Kansas City, Mexico & Orient. What eventually came to be the famed Chihuahua Pacific Railway was not completed until over 50 years after Stilwell’s death.Over several decades KCS earned the reputation of being profitable, efficient and compact. Its diverse commodity mix generated enough revenue for classification as a US Class I carrier, but its route structure and operating philosophy was more regional in nature.Deregulation spurs changeWere it not for two important developments, KCS might have remained a regional carrier. The first was the partial deregulation of the US rail industry following the Staggers Act of 1980, which unleashed a huge potential for change and growth. Deregulation led directly to consolidation; whereas there had been over 40 ’major’ US railroads prior to Staggers, by the late 1990s the number was less than 10 and falling.For the most part the mergers strengthened the industry, enhanced customer service and promoted greater competition. But they profoundly changed our marketplace. While KCS was able to hold its own against slightly larger competitors, the long-term prospects surrounded by a few giants were not as sanguine. Three mergers in particular: Union Pacific + Chicago & North Western (1994), Burlington Northern + Santa Fe (1995), and Union Pacific + Southern Pacific (1996), effectively redrew the rail map of the western United States. And KCS was all but erased.The other major development that helped reshape the company’s destiny was the passage of the North American Free Trade Agreement. Essentially, Nafta recognised that economic growth in the continent has shifted from east-west to north-south. The southern tier of the country – running from Georgia and Florida to Texas and on to the southwest – experienced enormous population growth and economic expansion.At the same time, Mexico was undergoing significant change. International companies with substantial manufacturing requirements were locating in Mexico, especially in the Monterrey area. Nearby Saltillo became one of the world’s largest automobile and truck assembly locations. The corridor between Mexico City and Monterrey became one of the fastest-growing manufacturing areas in the world.All of a sudden, the north-south KCS network was no longer contrary to the economic trend. An opportunity had opened up where there was none before. That opportunity enabled us to rethink our operations and take advantage of growing Nafta-related trade.But this opportunity raised a series of more complex questions. Should KCS hunker down in the middle of a market place dominated by giants? Or should it use the prevailing economic growth patterns to expand its own markets and become a viable alternative to some of its larger competitors? Should KCS remain strong, and do what it could to remain profitable until it was inevitably swallowed up by one of the large Class I’s? Or should it attempt to grow and put together a network strong enough to compete into the 21st century?Friends South of the BorderAround the same time that KCS reached this crossroads, Transportaciónes Maritima Mexicana was also evaluating how it could best expand its operations in North America. As Latin America’s largest transport company, TMM is predominantly an ocean shipping line, linking 41 ports in 23 countries around the world. It also has a trucking subsidiary providing intermodal services in Mexico in connection with its port operations.TMM was acutely aware of the growth under way in Mexico. It also perceived that the country’s deteriorating rail network could prove a drag on prospects for sustained economic activity. Foreign investment had kick-started the nation’s economy, but its deficient transport infrastructure posed a serious threat to long-term prospects.Despite the poor state of the national road network, trucking had become the dominant force in Mexican freight transport. The state-owned railways were deteriorating rapidly from lack of investment. As the quality of rail services worsened, shippers were increasingly switching to road, cutting revenue and accelerating the spiral of decline. In the 1980s and early 1990s, rail’s share of the total Mexican freight market fell from 20% to barely 12%, compared to a figure of 35 to 40% for the US market. Conditions had reached the point where only those with no alternative used the Mexican railways.TMM added its weight to an increasingly strident lobby calling for the Mexican government to privatise the railways. It saw two major benefits. First, in general terms, private enterprise could provide the investment and incentive for upgrading the network to handle increased freight volumes. Second, rail privatisation might give TMM the opportunity it was seeking to expand its activities both within Mexico and across the border into the United States. As the privatisation movement gathered momentum during the 1990s, TMM made its first strategic rail acquisition, buying the Texas – Mexican Railway. Tex-Mex operates the 240 km route from Laredo to Corpus Christi, Texas, and also owns the northern half of the International Bridge at Laredo, the busiest rail connection between Mexico and the USA. Ownership of the US portion of the bridge means Tex-Mex benefits directly from any increase in cross-border trade. And the purchase gave TMM the entry it wanted into the North American rail market.The Nafta partnershipTMM then began to seek actively a US Class I partner with which it could pursue more aggressively participation in the Mexican rail privatisation. Besides the rail expertise that such a carrier would offer, TMM also wanted a partner that would benefit directly from increased traffic to and from Mexico.Despite readily-available projections of extraordinary trade growth as a result of Nafta, TMM did not get a particularly enthusiastic reception from the US railroads that they contacted. Most saw Mexico as a high-risk venture, largely unknown to those railroads expanding along an established east-west axis. They found it difficult, if not impossible, to factor in Mexico as a central element in their business plans.But it was a different story when TMM approached Kansas City Southern. With its historical north-south focus, KCS immediately saw the potential of the Mexican rail network, particularly the 4000 km Ferrocarril del Noreste running from Mexico City through Monterrey to the Texas border. In-depth discussions led to a partnership agreement, and the concept of a ’Nafta Railway’ was officially born.The partnership was cemented in 1995 when KCS became 49% owner of Tex-Mex. Then the two companies began what we feel was probably the most detailed, thorough and sophisticated due-diligence investigation ever performed on a railroad.Central to our analysis was a market survey of Mexico’s 160 largest shippers, which brought out two important findings. Firstly, the Noreste was by far the crown jewel of the Mexican railways. Secondly, there was huge demand for a high quality rail service along this corridor. From the data collected during this survey, as well as a close investigation of the infrastructure of the entire Mexican network, KCS and TMM drafted marketing and operating plans for the Noreste. After comparing projected revenues with estimates of operations-related expenses, the partners were in a position to bid for the 50-year operating concession. Conventional wisdom held that the consortium including Union Pacific would win the Noreste. After all, UP had been the primary US operator doing business in Mexico for decades, and its power and influence within the industry was second to none. This was evident in the acquisition of the Southern Pacific in 1996 despite widespread concern among shippers, the government and elected officials. Most observers thought the Mexican jewel would surely end up in UP’s crown.But TMM and KCS had done their homework. The partnership had a more sophisticated knowledge of the market and the existing infrastructure than any of the other prospective bidders. TMM’s knowledge of the Mexican markets and strong relationship with government officials was coupled with KCS experience of rail operations in a highly competitive alliance. On November 29 1996 the partnership entered a sealed bid of US$1·4bn for the Noreste, under the aegis of a joint venture company known as Transportación Ferroviaria Mexicana. A week later, on December 5, TFM was awarded the concession.The Noreste is in many ways the railway that executives can only dream about. The corridor is dense in population and commercial activity – although accounting for only 19% of Mexico’s rail network, TFM handles over 40% of all rail freight. Its routes serve almost 70% of the population, including the primary industrial centers of Mexico City and Monterrey and the major ports of Lazaro Cardenas, Tampico and Veracruz, which are also served by TMM ocean-going vessels. It connects with US railroads at Laredo, the largest rail gateway between the two countries.Since the actual handover of Noreste operations on June 23 1997, TFM has done nothing to disappoint the expectations of rail analysts or its owners TMM and KCS. For the first six months, TFM’s revenues were more than US$26m over plan. We forecast that revenues could surpass US$1bn a year by the middle of the next decade. If anything, the demand for a quality railway serving shippers along the corridor is even greater than the most optimistic estimates to date. With US-Mexican cross-border trade growing by around 17% a year, our target of lifting rail’s market share back over 20% looks set to be accomplished on schedule, if not before.Of course, we need to recognise that TFM is still in its start-up phase. It is impossible to turn around completely in one year a system that had been allowed to deteriorate for decades. While the Mexican government maintained the tracks and key service buildings along this corridor, TFM inherited an under-maintained and seriously under-powered locomotive fleet. The rolling stock was also in bad repair, with a marked shortage of the kinds of cars needed to move most of the commodities now using rail.Likewise the signalling and information technology necessary for operational efficiency and customer service in the 1990s were almost non-existent. Financial reporting and billing systems were also deficient. There was a very understaffed and inadequately trained marketing organisation. There were no standards for locomotive or car utilisation, and safety standards barely existed and were not enforced.All that is changing. TFM is committed to being as efficient and well-managed as the best of the US Class I railways. Over US$700m will be invested during the first five years of the concession, of which US$200m is being spent in the first 12 months. Right-of-way improvements during the second half of 1997 accounted for US$36m. TFM is due to receive 75 new diesel locos from General Electric at the rate of five per month staring this month. They will be followed from January 1999 by 75 General Motors SD70MAC diesel locomotives to be assembled at Bombardier’s Concarril works near Mexico City, bringing the total investment in locos to US$300m by 2000.In terms of operational quality, US railway managers with decades of experience in operations and marketing, working with highly skilled and dedicated Mexican employees, have made tremendous progress in less than a year. While there is still work to be done, there can be no doubt TFM will be a world-class operation within the next two or three years.North to CanadaWhile the Mexican venture has been our biggest expansion so far, the Nafta corridor also stretches north to Canada. This too offers growth potential, and it is perhaps no coincidence that the other major north-south Midwest Class I, Illinois Central, has agreed to merge with Canadian National.However, KCS had already started to look north. Within a few days of winning the TFM concession in December 1996, we had reached agreement to take over Gateway Western Railway – a mid-1980s spin-off from the then Illinois Central Gulf. Linking Kansas City with Springfield, Illinois, GWWR has haulage rights into Chicago, giving KCS access to the biggest hub of the US rail network. From here it is but a short step to the Canadian border. We also have a marketing agreement with the 1 840 km I&M Rail Link, allowing KCS to arrange service into the Upper Midwest and Canadian market. Operating in Iowa and Minnesota, I&M is owned 66% by the Washington Organisation (which also controls Montana Rail Link) and 34% by Canadian Pacific Railway.In just a few years, KCS has transformed itself from a small regional carrier into an extensive international rail network. More importantly, this expansion has been developed within the context of the most powerful economic growth engine on the continent, ideally positioning us for the future.The Nafta Railway is still a work in progress. KCS is planning for further expansion – both through marketing alliances with other railroads and through strategic acquisitions – to enlarge our market reach and strengthen the network. With a strategic vision based on powerful economic growth patterns, Kansas City Southern is looking forward to exciting growth opportunities in the years ahead. oCAPTION: KCS forms the heart of a group of railways which connect Chicago to Mexico, accomplishing the original 1897 aim of creating a north – south corridorCAPTION: The Nafta Railway combines KCS (including MidSouth and Gateway Western), TFM in Mexico and I&MRail Link providing the link to Canadian PacificCAPTION: Crossing the Rio Bravo is a TFM freight hauled by a ’Nafta’ liveried loco The Noreste is in many ways the railway that executives can only dream about. Michael R HavertyKansas City Southern Railwaylast_img read more

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Sagrera station

first_imgSPANISH Development Minister Francisco Álvarez-Cascos and the Mayor of Barcelona Joan Clos have signed an agreement to build a station at Sagrera for the high speed line between Madrid and the French border. The Ministry of Development will be responsible for the railway infrastructure component of the Pts77bn scheme, with the remainder to be funded by property development.The three-level station will have eight tracks for high speed services and five for 1668mm gauge suburban services. Served by Lines 4 and 8 of the Barcelona metro (MR 00 p31), the interchange will also incorporate a bus station.Expected to open in 2004, the high speed line will approach Sagrera from the west using the existing cross-city rail tunnel under Carrer d’Aragó. A new tunnel will be built to the north under Carrer de Mallorca for suburban services, which will also be diverted from the existing tunnel to Sant Andreu Arenal under Avinguda Meridiana to serve Sagrera.Elsewhere, Prointec has been awarded a Pts220m contract to undertake preliminary design studies for a Madrid – Alclast_img read more

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Hitachi Rail Global moves to UK and announces expansion plans

first_imgHITACHI: On March 20 Hitachi Ltd announced that ‘to further accelerate the globalisation of the rail systems business’, the headquarters of Hitachi Rail Global would move from Japan to London, with head of Hitachi Rail Europe Alistair Dormer appointed to the new post of Global CEO, Hitachi Rail, from April 1.Hitachi Ltd said this would strengthen the management structure for worldwide expansion in the rail systems business. Kentaro Masai has been named as Global Chief Operating Officer and Shinya Mitsudomi as Global Chief Strategy Officer. Hitachi has 326 000 employees worldwide, with revenues of ¥9tr in the year to March 31 2013. Its rail business is expected to grow from 2 500 people today to 4 000 in the next 2½ years, and the company aims to grow rail turnover from €2bn to €3bn in the next few years. Hitachi estimates that the size of the world rail systems market averaged ¥18tr in 2009-11, and anticipates an increase to an average of ¥20tr in 2015-17, with steady expansion projected at an annual rate of 2·6%. ‘Today’s announcement is a significant sign of intent by Hitachi to grow its business in the rail market and I am excited by the level of trust placed in me to lead our growing business in this next phase of expansion’, said Dormer. ‘Both the UK and Japan remain important as markets for Hitachi Rail, and with our train factory in the northeast of England now under construction, we will work to realise our export potential from the UK, expanding into Europe and emergent markets.’last_img read more

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HS1 concession sold on

first_imgUK: A consortium including South Korea’s National Pension Service has agreed a £3bn deal to purchase the 30-year concession to manage High Speed 1 from the two Canadian pension funds which have managed the line since November 2010.The concession covers the operation and maintenance of the 109 km rail link between London and the Channel Tunnel plus the four stations at London St Pancras, Stratford, Ebbsfleet and Ashford International. It was awarded by the UK government to Borealis Infrastructure, the investment arm of Ontario’s municipal pension fund OMERS, and the Ontario Teachers’ Pension Plan under a deal valued at £2·1bn. The two funds revealed earlier this year that they had launched a ‘strategic review’ of the business after being approached by potential buyers.Borealis and OTPP confirmed on July 14 that they had ‘entered into a definitive agreement’ to sell HS1 to a consortium comprising funds advised and managed by InfraRed Capital Partners Ltd and Equitix Investment Management Ltd. InfraRed is advising third party funds including HICL Infrastructure and NPS. The members of the consortium will acquire interests in HS1 pro rata to their respective shareholdings, with HICL and the Equitix funds acquiring 35% each, and NPS the remaining 30%. They noted that ‘each of the consortium members has a proven track record of owning and managing UK infrastructure businesses’.Equitix Chief Investment Officer Hugh Crossley said the ‘high quality UK PPP asset’ was ‘attractive to our underlying Limited Partners and we expect to remain invested in it for the full duration of the concession.’According to OTPP, HS1 handled more than 75 000 trains during 2016, with its principal customers, Southeastern and Eurostar, carrying more than 20 million passengers. HS1 Ltd is reported to have made an operating loss of £94m for the year to March 2017.‘HS1 has delivered significant economic benefits to the UK and has enabled the regeneration of a number of areas along the route’, said OTPP Senior Managing Director Jo Taylor. ‘We are confident that HS1 will continue to prosper under its new ownership.’ OMERS Executive Vice President & Global Head of Infrastructure Ralph Berg added that ‘the business has become a reference point for the quality and reliability of its service’.last_img read more

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